Abstract
Introduction
Multi-level non-contiguous spinal injuries are not uncommon and their incidence varies from 1.6 to 77% depending on the type of imaging modality used. Delayed diagnosis and missed spinal injuries in non-contiguous spine fractures have been frequently described which can result in significant pain, deformity and neurological deficit. Mulitlevel injuries patterns have been studied in the past using X-rays and occasionally CT scans. With the growing use of MRI in assessment of spinal trauma scenario the impact of whole spine MRI in evaluation of multilevel injuries have not been assessed in the past. We performed this study to evaluate the impact of using whole spine sagittal MRI in the multilevel spine injuries.
Methods
Consecutive spinal injury patients treated between 2011 and 2013 were retrospectively evaluated based on clinical and radiographic records. Patient demographics, mode of injury, presence of associated injuries, clinical symptoms and the presence of neurological deficit were studied. Radiographs of the fractured region and whole spine MRI were evaluated for the presence of multi-level injuries We evaluated 484 consecutive patients undergoing whole spine sagittal MRI for multilevel injuries, missed injuries and analyzed the images for specific injury patterns.
Results
Among 484 patients, ninety five (19.62%) patients had multilevel injuries including 86 (17.76%) with noncontiguous injuries. Five common patterns of non-contiguous spinal injuries between different regions were observed. Pattern I: Cervical and thoracic- 29.1%, Pattern II: Thoracolumbar and lumbosacral - 22.1%, Pattern III: Thoracic and thoracolumbar- 12.8%, Pattern IV: Cervical and thoracolumbar - 9.1% and Pattern V: Lumbosacral and associated injuries- 9.0%. Whole spine MRI scan detected 24 (28.6%) missed secondary injuries of which 5 were unstable. Fall from height was the most common mechanism of injury I in 200 (51.6%), and road traffic accidents contributed to 145 case (37.1%). Neurological deficit was present in 251 patients (64.5%). Complete neurological deficit (ASIA A) was observed in 131 cases(53.3%) while incomplete deficit was present in 120 cases(47.8%). One twenty six patients (32.4%) had associated non-spinal injury including head injury (n = 19), chest injury (n = 22), abdomen injury (n = 4), pelvic injury (n = 6) and extremity injuries (n = 75).
Conclusion
The incidence of multilevel non-contiguous spine injury using whole spine MRI imaging is 17.76%. Five different patterns of multi-level non-contiguous injuries were found with the most common pattern being the cervical and thoracic level injuries. The incidence of missed injuries identified using whole spine MRI was as high as 28.6% and among them the incidence of unstable injuries can be as high as 21%.